1. Effectiveness of Culturally Adapted Strengthening Families Program in Four Countries: USA, Spain, Portugal, Austria
Dr. Karol Kumpfer Psychologist and Professor,
Dept of Health Promotion and Education University of Utah
Consultant, UNODC Vienna, Bangkok and Iran (2007 to present)
Director, DHHS SAMHSA CSAP Washington, D.C. (1997 to 2000)
Strengthening Families Program (SFP) Developer and Evaluator (35 countries)
Marcia Baker, PhD Candidate Health Psychology Trainer Strengthening Families Program 15 years Professor Springfield College-Houston Campus Mental Health Counseling Coordinator

2. Family Based Interventions Needed
Adolescent behavioral health problems
on the rise world wide
SAMHSA, % adolescents diagnosed with mental health or substance abuse disorder
Prevalence rates 38% anxiety, girls and 33% impulse disorder, boys

3. Parents Matter: Connecting the Dots
Parents and Elders are Role Models for Children
Drug exposed children are at higher risk for addictions for genetic, epigenetic, and environmental reasons

4. Biological and Genetic Risk Factors (Kumpfer, 1987)
Over Stressed Youth Syndrome
(related to Type II Alcoholism due possibly to one or two short alleles of 5-HTTLPR serotonin transporter gene)
Difficult Temperament
Hyperactivity, Rapid Tempo
Autonomic Hyperreactivity
Rapid Brain Wave (Schuckit, 1986)
Decreased Verbal IQ and
Prefrontal Cognitive Dysfunction Rapid Metabolism of Alcohol
Fetal Alcohol & Drug Syndrome (Chasnoff,
2009)

5. Nurturing Parenting Prevents Phenotypic
Expression of Inherited Genetic Risks
(Jirtle, 2010; Kumpfer, Xie, & Hu, 2010)
Epigenetic research in mice demonstrates Nurturing Parenting (LG mother mouse) prevents phenotypic expression of inherited diseases, such as:
Over-stressed Youth Syndrome
Obesity
Cardiovascular Disease
Cancer
Hence, effective positive parenting programs are critical to reducing social and health care costs long-term.

6. Lack of Nurturing Parenting Can Lead to
Developmental Delays
(Kumpfer, Fenollar, & Jubani, 2013)
Lack of a nurturning parent can program increased cortisol stress reactions in children resulting in—
Less exploratory behaviors,
Reduced cognitive development, and
Less oxytosin binding even in later generations. (Champagne & Meaney, 2007; Champagne, ).

7. Epigenetic 5 Year SAAF (African American SFP Years) Follow-up Study (Brody, et al., 2009, 2010; 2012; Murry, et al., 2012).
African American families of 7th graders were recruited from randomly assigned schools got Strong African American Families (SAAF) (n = 350 AA families) or minimal comparison intervention of 3 health booklets (n = 291 AA families),
Five years later researchers genetically tested students using saliva tests and identified the at risk kids with 1 or 2 short alleles of the 5-HTTLPR transporter gene.
40% of Americans carry these genes and are more likely to be impulsive and become substance abusers, depressed, and delinquent, but not if family stress is reduced.
SFP reduced substance abuse, delinquency, depression/anxiety and HIV risk by 50% five years later when kids were 18 years old

8. Protective Factors Leading to Positive
Child Outcomes: Social Ecology Model
(Kumpfer, Alvarado, & Whiteside, 2003)
F = .21
M= .27
Normed Fit Index
F: .90
M: .92
Academic Self-Efficacy
Self-Control
F = .19
M= .16
F = .71
M= .71
Family Bonding/ Nurturing
F = .88
M= .88 Positive Child
Outcomes
F = .43
M= .36
Family and Peer Norms
Family Supervision
F = .62
M= .55
Female: (n=5,488)
Male: (n=3,023)
Social and Community Prevention Environment
F = .12
M= .17

9. The Strengthening Families Program (SFP)

10. Development of SFP The first family-based program proven effective for
substance abusing parents and their children
Developed on a NIDA grant for high-risk families with children ages 6-11
1994 Adapted for universal families, ages Adapted for at-risk families, ages Adapted for at-risk families, ages 3-5
2010 SFP6-11 & SFP12-16 available in Spanish
2010 SFP Birth to 3 under development SFP 8-16 Years Home Use DVD
Proven effective with universal and at-risk families

11. First Hour Simultaneously
SFP Session Plan
FAMILY STYLE
MEAL
First Hour Simultaneously +
Second Period
PARENT
GROUP
2 Leaders
CHILD/ TEEN GROUP
2 Leaders
FAMILY GROUP or GROUPS

12. SFP12-16: Parents’ Class 1. Introductions and Group Building
2. What Teens Can Do & How to Manage Stress
3. Encouraging Good Behavior
4. Goals and Objectives
5. Communication for Better Relationships
6. Communication and Family Meetings
7. Helping Your Teen Handle Peer Pressure
8. Alcohol, Drugs and Families
9. Solving Problems and Giving Directions
10. Relationships, Love and Sexuality
11. Setting Limits I
12. Setting Limits II
13. Contracts for Changing Behavior
14. Building on your Successes

13. Children’s Social Skills
Hello and Group Rules
Speaking Skills
Listening Skills
Secret Rules of Success
Saying “No” to Trouble
Reflective Listening
Communicating Clearly
Alcohol, Drugs and the Family
Problem Solving
Introduction to Parent’s Game
Recognizing Feelings,
Dealing with Criticism
Coping with Anger
Community Supports, Graduation

14. Family Skills Training
1. Dreams and Goals: Treasure Maps Child’s Game, Positive Play
Goals and Objectives
Making Chore Charts and Spinners
Family Meeting Practice
Family Game: Active & Reflective Listening
Alcohol, Drugs and the Family
Problem Solving Game
Parent’s Game Practice
Review/Graduation Preparations
Graduation

15. Group Leaders Top Qualifications for Group Leaders:
sincere desire to help families
personal skills: one-to-one and in group
understanding why and how SFP works
4 Group Leaders: 2 for Parent Group,
2 for Kids’/Teens’ Group = 4 for Family Group(s)
Balance Group Leader teams to include men & women, ethnicities; for balance, consider using both staff and hourly contracted group leaders.

16. Research on SFP

17. SFP is an Evidence-based Model Program
SFP listed as a best practice or effective program by:
NIDA Red Book (one of 10 programs)
OJJDP Strengthening America’s Families
(1 of 7 replicated programs)
SAMHSA Model Programs (2000)
DoED (one of 8 programs)
OJJDP BluePrints (one of 10 programs)
Cochrane Collaboration (Foxcroft, et al., 2003) as best substance
abuse school-based program in world.

18. Strengthening Families Program Research Results
NIDA ( ) clinical trial research, 12 RCTs (8 independent RCTs by Spoth, Gottfredson, Brody, Murry, and Coatsworth), and 15 SFP CSAP-funded culturally adapted replications of found positive results in:
Improved parenting knowledge & skills
Improved family relationships
Improved children’s social skills and behavior

19. (Kumpfer & DeMarsh, 1986, Kumpfer, et al., 2008, 2012)
SFP Results: Parent (ES < .50 to .75)
(Kumpfer & DeMarsh, 1986, Kumpfer, et al., 2008, 2012)
Increased parenting efficacy
Increased parenting skills
Increased marital communication
Decreased stress
Decreased depression
Decreased alcohol & drug use

20. SFP Family Results (d <. 60 to .80)
(Kumpfer & DeMarsh, 1986, Kumpfer, et al., 2008, 2012)
Decreased family conflict
Increased family bonding
Increase positive communication
Increased family organization—family
meetings, chores done
Improved parent/child relationship
Increased family strengths and resilience

21. SFP is the Most Effective ATOD Prevention Program
(SAMHSA, Miller and Hendrie, 2008; Foxcroft, et al. 2003)
Percent of Youth Prevented from
Using—
Strengthening Families Program vs Life Skills
18% vs. 1% alcohol
15% vs. 3% marijuana
10% vs. 3% other drugs
7 % vs 7% tobacco •

22. SFP 10-14 Positive Results in Reduced Alcohol Initiation
Alcohol Initiation Index Trajectories for SFP vs. No-tx Control
1.5
1.3
1.1
0.9
0.7
0.5
0.3
0.1
Control
IFP
MONTHS

23. SFP Prevents Mental Health Problems:
10 Year Iowa SFP (10-14) Follow-up:
300% reduction in depression
280% reduction in social anxiety
260% reduction in phobias
220% reduction in anti-social personality
Not a single young adult (up to 23 years of age) had used meth compared to 3.2% in the control schools

24. Steps to Implementing Culturally
Adapted EBPs (Kumpfer, et al., 2008; UNODC, 2009)
Conduct Needs Assessment including:
Surveys of Parent, Youth and Teachers or
Existing Archival Information
Key Leaders
Research family EBPs and select best program
considering:
age,
ethnicity, and
risk level of familes (e.g., universal, selective or indicated prevention approaches and one with largest effect sizes),
Create a cultural adaptation team including family members and developer

25. Steps to Cultural Adaptation of Evidence-based Programs (EBP)
Translate curriculum and training materials into local language and do minor cultural adaptations,
Change graphics, stories, songs to reflect
the new culture,
Remove obvious culturally inappropriate material (e.g., look at person when speaking),
Implement basically “as is” with minimal
adaptation at first,
Do not remove core content or shorten,

26. Steps to Cultural Adaptation of Evidence-based Programs (EBP)
Have implementers from local culture who make gradual changes based on what works (culturally appropriate language, stories, songs).
Continuously make additional cultural adaptations and add to curriculum with program developer’s approval.
Continuously conduct process and outcome
(pre-and post-test) evaluations of cultural
adaptations.
Disseminate the culturally adapted version to similar cultural groups, if effective.

27. Steps to Cultural Adaptation of
Evidence-based Programs (EBP)
Support the new country to develop it’s own training and dissemination system through capacity building,
Pick out implementers from the new culture who are “true believers” and have the personal charisma to be trainers of other implementers,
Co-train with them until they can run their own training workshops,
Support grant writing and funding development efforts for new program, and
Support web-site development, new videos.

28. SFP Youth Results Across Five Multicultural Studies
(Kumpfer, Alvarado, Smith, & Bellamy, 2002)
Decreased depression
Decreased conduct disorders
Decreased aggression
Increased cooperation
Increased social competencies
Increased school grades
Increased number of pro-social friends
Decreased tobacco, alcohol or drug use

29. Results of SFP Cultural Adaptations
(Kumpfer, Alvarado, Smith, & Bellamy, Prevention Science, 2002
Five quasi-experimental studies evaluated results of cultural adaptations in Years 3-4 compared to original SFP in Years 1-2
Recruitment and retention increased by
average of 40% for cultural adaptations
Outcomes basically identical, but slightly worse if adaptation involved reducing number of session or changing order
Cultural adaptations also accomplished by hiring culturally competent group leaders

30. SFP Cultural Adaptations
African-American, rural and urban
Pacific Islander version
Canadian version
Australian version
American Indian versions
35 countries (UNODC and PAWHO) including Swedish, Norwegian, Dutch, UK, Irish, Italian, Greek, Portuguese, French, Thai, Chinese, Burmese, Persian, German, Russian, Slovenian, Serbian, Croatian, Bosnian, Spanish for Central and South America, etc.
Culturally adapted versions got results similar to standard versions, but much better recruitment, retention. Key: recognition, respect for identity.
SFP course materials are culturally sensitive; delivery of SFP is always meant to be culturally specific.

31. 10-session SFP DVD Contents and Results

32. “Strengthening Families Program” skills now on Home-Use DVD
10 video classes with downloadable handouts
Print handouts off the DVD disk itself
Parents and kids watch
together at home;
pause DVD, practice skills

33. Home-Use DVD= Systematic, fun way to teach SFP family skills
•Parents and kids watch together;
pause the DVD and PRACTICE skills
•Real-life problems & solutions
Complex relationship skills are
broken down into small steps
Downloadable handouts
reminders of skills
tracking behavior
•Inexpensive, effective
•Young kids love it!

34. * Targets Risk & Protective Factors with Research-Proven skill set to prevent youth substance use/abuse
BONDING/NURTURING (create warm, loving relationships)
Setting BOUNDARIES
(clear firm rules and consequences)
MONITORING kid’s activities (see they stay in alcohol and drug-free social environment)

35. INTRO: Healthy Family Skills = Healthy Brain
Skills Taught:
Eat dinners together
Play one-on-one
Squash the A.N.T.s
(Automatic negative
Thoughts)
Risk & Protective Factors
Family Attachment
Perceived risk of drug or alcohol use

36. Lesson 1: Notice & Compliment the Good Daily
Skills Taught:
Risk & Protective Factors:
•Family Attachment
•Family Bonding
•Increased Social Skills
Notice the good
Give “Reinforcing
Compliments”
Cease to criticize

37. Lesson 2: Communication & Family Meetings
Skills Taught:
L.U.V. Listen
Use “I-Messages”
Banish Communication Boulders
Assertive vs. Aggressive
Risk & Protective Factors:
•Family Bonding
•Family Attachment
•Increase in Social Skills

38. Lesson 3: 5-R’s Of Successful Families:
Rules, Rewards, Responsibilities, Routines, Rituals
Skills Taught:
Risk & Protective Factors:
•Poor Family Management
•Family Attachment
•Clear Standards
Make/Obey Fam. Rules
Give Rewards
Teach Responsibilities
Set up Routines/Rituals

39. Lesson 4: Set Limits & Consequences
Skills Taught:
Risk & Protective Factors
•Clear limits
•Positive Discipline (not lax or harsh)
•Consistent consequences
•Handle rebelliousness
effectively
Use Positive Discipline
Teach Needed Behaviors
Give Fair Consequences
Be Calm and Consistent
Express Love Afterwards

40. Lesson 5: Problem solving, Pre-problem solving,
& Win-Win Negotiation
Skills Taught:
Problem Solving
Fair Negotiation
Pre-problem solving (look ahead,
avoid trouble)
Practice Refusal Skills
Risk & Protective Factors:
•Problem solving
•Pre-Problem Solving to avoid anti-
social behavior
•Good Refusal Skills

41. Lesson 6: Stress & Anger Management Skills
Skills Taught:
Reduce Stress; Trigger own Relaxation
Response
Track Anger Triggers, ues
Program brain with new pro-social
responses
Risk & Protective Factors
•Family Conflict
•Stress management
•Increase in Social skills

42. Lesson 7: Goals & Contracts to Change Behavior
Skills Taught:
Risk & Protective Factors:
•Parental involvement in
child’s life
•Poor classroom behavior
•Low commitment to school
•Academic failure
Determine life’s goals and wanted
behaviors
Set-up S.M.A.R.T. Goals
Make Contracts to change behavior;
follow-up

43. Lesson 8: ATOD Hijack Brain’s Pleasure Center
Skills Taught:
Risk & Protective Factors
•Parental attitudes favorable toward alcohol
& drugs
•Perceived risk of drug or alcohol use
•High ATOD resistance skills
Recognize brain-harm of A.T.O.D.
Parents use Bonding, Boundaries, Monitoring
Effective Refusal Skills

44. Lesson 9: Choose Good Friends; Monitor Activities
Skills Taught:
Risk & Protective Factors:
•Parental Monitoring
•Increase in Social skills
•Bonding to peers with healthy beliefs, standards
•Interaction with Anti- social/Drug-Using Peers
Identify, make good friends
Be a good example
Use Refusal Skills
Monitor all kids’ activities
Help provide healthy fun

45. Lesson 10: Values, Traditions & Service
Skills Taught:
Risk & Protective Factors :
Teach Family Values
Establish fun traditions
Recognize blessings &
need to give to society
Look for ways to serve
Opportunities for Pro- social Involvement
Belief in a Moral Order
Healthy beliefs, standards
Strong neighborhood attachment

46. U of Utah Funded Evaluation
8 randomized matching inner city schools (6th & 8th grades/low and higher SES); half or 125 getting new SFP 8-16 Yrs Group Classes; half or 125 Home- Use DVD only
58% ethnic families
55 DVD parents took on-line survey using same SFP standardized test (21 Parenting, Family and Child outcomes) on June 10, 2011 (first wave), and May 8, 2012 (second wave)
Preliminary results: Home-Use DVD produced nearly equivalent outcomes for much reduced cost :
$5 vs. $1,500 per family in Group Class.

47. SFP Home-Use DVD Outcome Results
PARENTING: 100% of the 6 Parenting outcomes
improved significantly using Home-Use DVD
Medium to large Cohen’s d effect sizes compared to larger effect
sizes for SFP (8-16 yrs) 10-Session Group Class
Home Use DVD 10-session DVD Class 14-session SFP class
Parenting Cluster
d = .60
vs. .77
(.64 SFP norms)
Parental Involvement
d = .47
vs. .73
(.54 SFP norms)
Parenting Supervision
d = .63
(.61 SFP norms)
Parenting Efficacy
d = .55
vs. .68
(.56 SFP norms)
Positive Parenting
d = .53
vs. .67
Parenting Skills
d = .39
vs. .59
(.47 SFP norms)

48. SFP Home-Use DVD Outcome Results
FAMILY:
100% of the 6 Family outcomes
significantly improved using Home-Use DVD
Medium to large Cohen’s d effect sizes compared to larger effect sizes for SFP(8-16 yrs) 10-Session Group Class
Home Use DVD 10-session DVD Class 14-session SFP class
Family Cohesion
d = .46
vs. .66
(.51 SFP norms)
Communication
d = .66
vs. .72
(.67 SFP norms)
Family Conflict
d = .20
vs. .40
(.20 SFP norms)
Family Organization
d = .70
vs. .74
(.68 SFP norms)
Strengths/Resilience
d = .69
vs. .78
(.66 SFP norms)
Family Cluster
vs. .81
(.70 SFP norms)

49. SFP Home-Use DVD Outcome Results
TEEN / YOUTH: 71% of the 6 Child/Teen outcomes significantly improved using Home-Use DVD (except Hyperactivity and Criminality; very low at pre-test)
Medium to large Cohen’s d effect sizes compared to larger effect sizes for SFP (8-16) 10-Session DVD Class
Home Use DVD 10-session DVD Class 14-session SFP class
Overt Aggression
d = .51
vs. .63
(.31=SFP norms)
Covert Aggression
d = .56
vs. .74
(.18=SFP norms)
Social Skills
d = .36
vs.
.55
(.37=SFP norms)
Depression
d = .31
.40
(.26=SFP norms)
Concentration
.74
(.51=SFP norms)
Child Cluster
.77
(.47=SFP norms)

50. (34 Best Practices Parenting Programs)
How to Contact Us
Strengthening Families Program
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SFP Training by Ahearn Greene and Associates and Lutra Group